Consider the case of an 837P transaction with three Loop ID-2400 service lines, each containing Loop ID-2420A with a different individual rendering provider NPI and all of those being different from the Loop ID-2010AA organizational billing provider NPI. Are we required to populate Loop ID-2310B, or are we allowed to omit it?
The Loop ID-2310B Situational Rule states, "Required when the Rendering Provider information is different than that carried in Loop ID-2010AA - Billing Provider." The use of the singular definite article "the" is ambiguous because it seems to apply to only a single rendering provider, whereas in our scenario there are three different rendering providers. Furthermore, the Loop ID-2420A Situational Rule states in part, "Required when Loop ID-2310B Rendering Provider is not used." That implies there are circumstances where it is valid to use Loop ID-2420A while omitting Loop ID-2310B. Is that correct? If so, can you explain the scenarios under which Loop ID-2420A can be used while Loop ID-2310B is omitted? Or is that part of the Loop ID-2420A Situational Rule essentially null, and if so, is Loop ID-2310B always required if the rendering provider is different from the billing provider, even if every service line also has Loop ID-2420A populated?
We are constructing an 837P transaction to send to a payer. The TR3 seems to be ambiguous as to whether Loop ID-2310B can legally be omitted when the rendering provider is specified in Loop ID-2420A. Existing RFI #2608 and #1902 are related to this question but do not seem to answer it directly.
Loop 2310B can only be omitted when the Rendering Provider information is the same as what is reported in 2010AA. In your example, it is not the same, so it must be sent.
We would recommend your example be submitted as follows:
2010AA – Billing Provider
2310B – Rendering Provider & NPI associated to Service Line #1
2420A – Not Sent on Service Line #1
2420A – Rendering Provider & NPI associated to Service Line #2
2420A – Rendering Provider & NPI associated to Service Line #3